Personal reflections, comment, discussion by and for doctors working in Aboriginal Medical Services or those who want to understand their work better.

Tuesday, September 4, 2012

Cultural Educators and Medical Educators at the GPET Convention

Here I am at the GPET Convention in Melbourne, and day one was of of many satellite meetings taking place, though this was the most important one as it is backed by 60,000 years of indigenous wisdom. The Cultural Educators and Medical Educators are a group of Aboriginal and Torres Strait Islander people and GPs involved in GP training at the junior doctor and registrar level. They work for Regional Training Providers (the organisations contracted to provide GP vocational training) and Aboriginal Community Controlled Health Services, with a smattering (like me - though I used to work for an RTP) from other organisations. The cultural educators and mentors met yesterday, too.

So, some thoughts on the day? It's always a pretty inspirational group of people, who are very committed to teaching high quality primary care led by Aboriginal communities. This group really gets this now - the message has to get out wider. Those who are not really interested in this message are those who need to hear it the most!

There was a lot of very good conversation, and some new ways of presenting some familiar information.

We heard about the tender AGPT put out for a project to look at developing the capacity of RTPs to be able to offer cultural education and mentoring, which will be carried out by a team led by Prof Jenny Reath at University of Western Sydney, with experienced cultural educators from WEstern Sydney, Queensland and the NT.

We heard about cultural safety from Richard Frankland (yes, that Richard Frankland!) with a good demonstration of the "cultural load" often carried by Aboriginal people, as someone was given more and more stuff to carry without dropping. He presented some familiar cultural concepts in a new way, which is always useful.

And we had some reflections on teaching in Aboriginal Health from Dr Mary Belfrage, Medical Director at Victorian Aboriginal Health Service. She gave a thoughtful talk, articulating some of the important concepts that we need to get across to do Aboriginal health well. I use the word articulate deliberately, as we often know these things without being able to find the right words to describe it. And when we use the wrong words, we smuggle in assumptions and attitudes that may be unhelpful.

Let's pick out some of the examples I found most striking. In thinking about the concept of families in Aboriginal communities, she described a conversation she'd had with someone who had asked people to name everyone they considered family. Aboriginal people named 800 to 1000. An alternative conception was to ask how many people would kiss your baby each day - 30 to 50. The high numbers were striking, which tell us about the extended range of caring and responsibility in Aboriginal communities. Also striking was her nuanced conception of cultural safety - both of the variety within Aboriginal cultures and in individuals expressions of that, and in the subtle exploration of difference, for example in the area of privacy and confidentiality, where listening and negotiation makes for a more effective alternative to either an individualistic secrecy or an everything goes openess, neither of which is appropriate.

There was also an appreciation of good GP skills - some of what we think of as good practice in Aboriginal health, is actually just what GPs everywhere should be doing. We should know how to develop trust. We should be kind - not soppy, not promoting dependency, but having regard to people's experience, their discomfort. We should understand how services are received by the user.

Most pertinently for me, because this is also the way my thoughts have been moving too, is the idea that "there are no Aboriginal diseases." She gave a great example of the idea of Aboriginality as a non-modifiable risk factor in renal disease. This sounds reasonable in doctor speak - we speak like this about all sorts of risk factors. But what we are saying is that being Aboriginal is the problem. But being Aboriginal is a wrap-up of all sorts of other risk factors - socioeconomic, colonisation, disposession - which have an impact. Fortunately, the risk factor was changed. I think this is a reallt important idea, and I'll blog more about this in the future. I'm glad that this sort of discussion is beinf heard more and more.